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Meta-Analysis
. 2022 Feb 24;109(3):256-266.
doi: 10.1093/bjs/znab436.

Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis

Christoph Kuemmerli  1   2   3 , Christoph Tschuor  1   4   5 , Meidai Kasai  6 , Adnan A Alseidi  7 , Gianpaolo Balzano  8 , Stefan Bouwense  9 , Marco Braga  10 , Mariëlle Coolsen  9 , Sara K Daniel  11 , Christos Dervenis  12 , Massimo Falconi  8 , Dae Wook Hwang  13 , Daniel J Kagedan  14 , Song Cheol Kim  13 , Harish Lavu  15 , Tingbo Liang  16 , Daniel Nussbaum  17 , Stefano Partelli  8 , Michael J Passeri  4 , Nicolò Pecorelli  8 , Sastha Ahanatha Pillai  18 , Venu G Pillarisetty  11 , Michael J Pucci  15 , Wei Su  16 , Robert P Sutcliffe  19 , Bobby Tingstedt  20 , Marion van der Kolk  21 , Dionisios Vrochides  4 , Alice Wei  22 , Caroline Williamsson  20 , Charles J Yeo  15 , Sabino Zani  17 , Efstratios Zouros  12 , Mohammed Abu Hilal  1   2
Affiliations
Meta-Analysis

Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis

Christoph Kuemmerli et al. Br J Surg. .

Abstract

Background: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy.

Methods: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission.

Results: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate.

Conclusion: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

Plain language summary

Enhanced recovery protocols consist of interdisciplinary interventions aimed at standardizing care and reducing the impact of surgical stress. They often include a short period of preoperative fasting during the night before surgery, early removal of lines and surgical drains, early food intake and mobilization out of bed on the day of surgery. This study gives a summary of reports assessing such care protocols in patients undergoing pancreatic head surgery, and assesses the impact of these protocols on functional recovery in an analysis of individual-patient data. The study revealed the true benefits of enhanced recovery protocols, including shorter time to food intake, earlier bowel activity, fewer complications after surgery, and a shorter hospital stay compared with conventional care.

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